The Truth About Botox

Mention the word "Botox" today and the reactions will range from outrage (Can you believe a mother injecting her eight year old daughter?) to condescension (I'll never use that.) to enthusiasm (It's the greatest thing in the world!). Botox is the most common non-surgical procedure in America with millions of people receiving treatments annually and its popularity continues to grow. Misinformation and preconceptions abound so what is the truth about Botox and other neuromodulators?

It all began in the 1820's when Dr. Justinus Kerner conducted experiments to find out why some people died after consuming sausage. He found it was food-borne botulism and began to study its paralyzing neurological symptoms for therapeutic use. In the 1890's, botulinum toxin strains A through G were identified, four of which (A, B, E, and F) can make humans sick. Starting in 1950, botulinum toxin type A was used in studies to control hyperactive muscles that caused pain, crossed eyes, spasms, overactive bladders, stuttering, TMJ, and similar problems. In 1989, the FDA approved botulinum toxin type A for treating crossed eyes and spasms in the eye muscles.

More research in the 1990's discovered that Botox temporarily cured excessive sweating and cerebral palsy symptoms. Then a serendipitous event occurred when ophthalmologist Dr. Jean Carruthers and her dermatologist husband noticed that her patients were looking fabulously wrinkle-free. After they published a study on the ability of Botox to decrease frown lines, Botox took off so much that we actually ran out of it for a short time in the late 1990's. With Botox Cosmetic officially approved in 2002 for correcting frown lines and then two years later for excessive underarm sweating, business has been booming with annual sales exceeding $1 billion.

Modifications to the process that purifies the botulinum toxin are creating similar neuromodulators to compete with Botox Cosmetic. In 2009, the FDA approved Dysport for the treatment of wrinkles and newer neuromodulators may become available in the next few years. Botox Cosmetic and Dysport are nearly identical from a clinical standpoint but the dosages are different and small variances have been found in the time required to show effects and how long the effects last.

When Botox Cosmetic was initially released, there was a lot of experimentation. Only physicians could obtain Botox (it was and is a prescription medication) but there was no restriction on who could administer the injections. Botox "parties" sprang up where dozens of people would purchase Botox from injectors with little or no training or qualifications. Believing that more must be better, some patients demanded that enough Botox be injected to prevent the slightest movement of wrinkle-causing facial muscles and the expressionless Botox face was born. With the expansion of the internet, illicit sources of Botox became common and stories would occasionally surface about people injecting themselves with unpurified botulinum toxin and temporarily paralyzing their entire bodies. More frequently, people would buy counterfeit Botox that had no effect at all.

As doctors and nurses became more familiar with Botox, they discovered how to tailor injections to eliminate wrinkles while retaining completely natural and expressive facial musculature. Correct dosages relax muscles rather than paralyzing them completely. Techniques have even been developed to inject small amounts of Botox into exact muscle points to produce slight eyebrow or jaw line lifts. Trained and experienced injectors can ensure that injections are virtually painless and produce the desired results.

If you are curious about neuromodulator injections, here are the really important questions…

How does it work? Wrinkles are caused by muscles that never completely relax. The tightened muscles force the skin above them together like an accordion, creating wrinkles. Neuromodulators block messages between the muscles and the nerves that control them, thereby relaxing the muscles and wrinkles above them. Neuromodulators are most commonly used for lines across the forehead, wrinkles between the eyes, "bunny lines" across the nose, crow's feet around the eyes, and fine lines around the mouth.

What results can you expect? The effects of neuromodulator injections normally become apparent after three to seven days and normally last for three to six months. The effects vary between individuals because sensitivity to the medication and the size and strength of the muscles being injected are not the same for everyone.

What are the possible side effects? Side effects are generally limited to the injection site and may include slight swelling or bruising. Headaches lasting several hours may occur. In rare instances, the medication may diffuse into adjacent muscles and weaken them for several weeks after an injection. All the possible side effects can be minimized by ensuring that the injections are performed by a trained and qualified person.

What should the injections cost? This question is a little tricky because some practices charge by the number of units of medication injected while others charge by the injection area. Botox and Dysport require different amounts of medication to produce the same results so their "units" are not the same. One practice may quote 10 units as normal for a given treatment area while another quotes 20 units. This is important because the amount of medication required varies between individuals and injecting 10 units into a person that requires 20 units will produce inferior results that wear off too soon.

In Tucson, normal Botox Cosmetic prices vary from $10 to $18 per unit depending on which practice you visit. Dysport requires two to three times as many units as Botox to treat the same area but most practices convert Dysport units to Botox units when quoting prices to avoid confusion (practices that only offer Dysport or do not convert Dysport units to Botox units will generally quote Dysport units anywhere in the $3.50 to $9.00 range). That means you can expect to be quoted $200-$500 for the forehead, $250-$550 for the glabellar (vertical creases between the eyebrows), and $250-$550 for crows feet around both eyes. We suggest you follow these steps to compare prices:

1. Determine if the practice uses Botox Cosmetic, Dysport, or both.
2. Ask the practice for their price per unit for each medication and the number of units they normally use to treat the area you are interested in. If they only quote prices by area, ask how many units of medication the area price is based on and divide the area price by the number of units.
3. Before you receive the injections, you should be examined by a doctor or nurse to determine the amount of medication you need. This may result in a different price than you were quoted before the examination.
4. If you receive injections priced by area, ask how many units of medication were actually injected (this is the only way to know if you were given an accurate figure at the start).
5. Beware of sale prices for the first 10 or 20 units of medication unless you know how many units you actually need and how much you will pay for additional units.

The conclusion is that Botox and Dysport are safe and they really do decrease or eliminate facial wrinkles. Deciding to treat wrinkles is a personal choice but one that can be made without fear of altering your appearance. Your friends may tell you that you look younger or happier but you can just tell them that you learned to relax. For information about the Botox and Dysport treatments offered at Skin Care By Design, click Botox or Dysport.

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